Diabetes and Eating Disorders

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Insulin-dependent diabetes mellitus (IDDM) is one of the most common chronic illnesses of childhood and adolescence in North America.1 Although most young patients with IDDM are healthy, up to 40 percent eventually have diabetes-related microvascular complications., The risk is greater in those whose diabetes is poorly controlled.4 Eating behavior is categorized under three commonly selected categories.4 Highly disordered eating is defined as the occurrence of one or more of the following forms of disordered behavior at least twice per week binge eating, omission or under dosing of insulin to promote weight loss, self-induced vomiting, or use of laxatives.4 Moderately disordered eating is defined as the occurrence of one or more of these forms of disordered behavior at least twice per month, but less than twice per week.4 Nondisordered eating is defined as the absence of disordered behavior or its occurrence less than twice per month.4 Up to one third of young women with IDDM have eating disturbances,5 which may affect the management of diabetes. Treatment of type 1 diabetes involves constant monitoring of food intake. In addition, the good glycemic control necessary to reduce the risk of long-term complications is associated with weight gain.6 In young women, these two factors, along with individual, family and social factors, can lead to an increased incidence of eating disorders, which can disrupt glycemic control and increase the risk of long-term complications.6,7,8 The coexistence of eating disorders and diabetes is associated with non-cooperation with treatment for diabetes,7 omission or under dosing of insulin to induce glycosuria and promote weight loss,8 and impaired metabolic control; 8 however, long-term effects of disordered eating on complications of diabetes are not known. Nevertheless, it is still determined that disordered eating behavior is associated with microvascular complications in young women with IDDM.

From June to December 188 (base line), 11 girls and women 1 to 18 years old were invited to participate in a self-reported survey of eating attitudes and behavior.7 These girls and women had previously diagnosed IDDM and were being followed in the diabetes clinic of the Hospital for Sick Children in Toronto. This represented all girls and women in this age group who attended the clinic during this period, except for one patient with cerebral palsy. Between July 1 and January 14 (follow-up), all of the participants were contacted again. Approximately one third were still attending the diabetes clinic, and the remainder had been referred to an adult treatment setting. Between study entry and follow-up, the research group did not have any contact with the study participants, except that one provided medical care for some of the patients at the clinic and another saw several patients for psychiatric assessment. The treatment for patients at the diabetes clinic between study entry and follow-up included regular quarterly visits and IDDM management in a multidisciplinary setting. It was also clinical practice to recommend a psychosocial assessment for patients with persistently high hemoglobin A1c levels or disturbed eating attitudes and behavior. During the follow-up interval, twenty-one patients reported that they had been assessed or treated for one or more of the following an eating disorder (), depression (), family problems () and other mental problems (4).

At base line and follow-up, demographic and clinical information was collected, height and weight were measured and body-mass index was calculated. Self-reported episodes of ketoacidosis and severe hypoglycemia in the preceding year were documented. A behavior related to eating and weight self-administered questionnaire was given at base line and follow-up. This questionnaire, which obtains information about eating habits from the previous three months, was changed to include diabetes-related items, including omission or under dosing insulin to promote weight loss. The patients either completed the questionnaire during their clinical visits or completed it at home and returned it by mail. Even with reminder calls, some questionnaires (eight at base line and nine at follow-up) were not returned.

Hemoglobin A1c was measured at base line and follow-up. Also, the urinary albumin excretion rate, a predictor of diabetic neuropathy, was determined at follow-up in both 1 and 4 hour urine samples; however, the results from the 4-hour samples were used as the most reliable measurement. Microalbuminuria was defined as an albumin excretion rate of at least 15 but less than 00 nanograms per minute, and macroalbuminuria as a rate of at least 00 nanograms per minute. Diabetic retinopathy was detected at follow-up by a retinal specialist who did not know the persons eating habits, hemoglobin A1c levels, or urinary albumin excretion rate. The level of retinopathy was derived by giving a greater weight to the eye with the higher level.10 With this classification, level 10 indicates no diabetic retinopathy; level 0, very mild retinopathy; level 0, mild nonproliferative retinopathy; levels 40 to 55 moderate-to-severe nonproliferative retinopathy; and level 60 or higher, mild to high risk proliferative retinopathy.10 Custom writing service can write essays on Diabetes and Eating Disorders

The results then showed that 107 (88 percent) of the 11 eligible girls and women participated at base line because 8 did not return their questionnaires and 6 refused to participate. Then, 1 (85 percent) of these 107 girls participated at follow-up because did not return their questionnaires and 5 could not be located. The characteristics of the patients at base line and follow-up are shown in Table 1.11

Also, the 16 patients who participated at base line but not at follow-up did not differ from the 1 who completed both assessments, in terms of age, age at onset of diabetes, duration of diabetes, hemoglobin A1c values, BMI and eating status at base line. Among the 11 patients who refused to participate or failed to return their questionnaires at follow-up, were classified as having highly disordered eating and had moderately disordered eating. The prevalence and persistence of disordered eating behavior are shown in Table .

Intentional omission or underdosing of insulin and dieting for weight loss increased in frequency from base line to follow-up. Binge eating, self-induced vomiting, and dieting for weight loss tended to continue at follow-up if they were not present at base line. Also, at base line, of the 1 young women met the criteria for highly disordered eating, 17 met the criteria for moderately disordered eating and 65 met the criteria for nondisordered eating. The nine patients with highly disordered eating did not differ from the others in age, but in duration of diabetes (+/-4 vs. 6+/-4 years). Table also suggested that disordered-eating status tended to persist over time because of the 6 patients with highly or moderately disordered eating at base line, 16 remained in these categories and 10 improved. Of the 65 patients with nondisordered eating at base line, 14 had disordered eating at follow-up.

At base line, the patients with highly disordered eating had a substantially higher hemoglobin A1c value than those with moderately disordered eating and nondisordered eating. Among the 14 patients who had constant disordered eating behavior and whose hemoglobin A1c values were measured at follow-up, the values were similarly high at both assessments. In the nine patients whose eating status improved, so did their hemoglobin A1c and decreased from .7+/-. to 7.6+/-1.4 percent. 71 of the 1 women had ophthalmologic examinations at follow-up and 4 of the 71 were found to have some degree of retinopathy. Sixteen had mild retinopathy, eight patients had nonproliferative retinopathy and one had advanced preproliferative retinopathy in one eye and early proliferative in the other. Urinary albumin excretion was measured in 7 of the 1 patients at follow-up. Twelve had microalbumuria (range, 15 to 66 nanograms per minute) and three had macroalbumuria (range, to 47 nanograms per minute). This association between disordered-eating status at base line and diabetes-related microvascular complications at follow up is shown in Table .

Results show that retinopathy was more common in patients with disordered eating at base line, but abnormal urinary albumin excretion was not.

Therefore, the most striking finding of this study is that some degree of retinopathy was present at follow-up in more than 85% of young women with IDDM who had highly disordered eating at base line, as compared with 4% in those with moderately disordered eating. Only 4% of those, however, with nondisordered eating had some degree of retinopathy. Furthermore, disordered-eating status accounted for more of the explained variance in a model predicting retinopathy than did duration of diabetes, an established risk factor for microvascular complications.4 Also, the average length of diabetes in the patients may not have been long enough for neuropathy to occur in enough patients to suspect an association with disordered-eating status. The limitations of the study, however, include incomplete participation in the follow-up medical examinations, limited reliability on the honesty of the self-report assessment, and absence of base line evaluations of microvascular complications.

This study, therefore, confirmed that in young women with diabetes, eating disorders do persist, to increase in frequency throughout adolescence, and to be predictors of poor metabolic control and their related complications. The increased prevalence of behavior designed to promote weight loss at follow-up is not surprising because more of the patients had reached the aged where eating disorders were at a higher risk. Also, apart from dieting to lose weight, intentional omission or under dosing of insulin was the most common means of inducing weight loss.

Prevention and early treatment of eating disorders in young women are important to prevent long-term complications and mortality. The health risk of these conditions is increased when they are associated with diabetes because of their effect on metabolic control and metabolic complications. In diabetic women with diabetes, the increased focus on eating and the weight gain associated with good glycemic control likely increase their susceptibility to abnormal eating. Although there is an emphasis on keeping weight down, a healthy diet should be stressed. Good nutritional counseling to help patients avoid weight gain and family counseling to improve communication between patients and their families may help decrease the risk. Intentional insulin omission is a frequent means of preventing weight gain or increasing weight loss in adolescent females with type 1 diabetes. Eating disorders should be suspected in patients with recurrent ketoacidosis or poor glycemic control that is resistant to attempts at improvement. Treatment includes decreasing dietary restraint, promoting healthy eating and either psychiatric counseling or psychologic intervention, or both. It is always important to remember that an eating disorder can be hidden easily and for many years, usually until the consequences are irreversible. 1.Drash AL. The epidemiology of insulin-dependent diabetes mellitus. Clin Invest Med 187; 10 4-46.

.Krolewski AS, Warram JH, Christlieb AR, Busick EJ, Kahn CR. The changing natural history of nephropathy in type I diabetes. Am J Med 185; 78785-74.

.Krolewski AS, Warram JH, Rand LI, Christlieb AR, Busick EJ, Kahn CR. Risk of proliferative diabetic retinopathy in juvenile-onset type I diabetes a 40-yr follow-up study. Diabetes Care 186;44-45.

4.The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1;77-86.

5.Rodin GM, Johnson LE, Garfinkel PE, Daneman D, Kenshole AB. Eating disorders in female adolescents with insulin dependent diabetes mellitus. Int J Psychiatry Med 186;164-57.

6.The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1;(14)77-86

7.Steel JM, Young RJ, Lloyd GG, Clarke BF. Clinically apparent eating disorders in young diabetic women associations with painful neuropathy and other complications. BMJ 187;485-86.

8.Rodin G, Craven J, Littlefield C, Murray M, Daneman D. Eating disorders and intentional insulin undertreatment in adolescent females with diabetes. Psychosomatics 11; 171-176.

.McKenna MJ, Arias C, Feldkamp CS, Whitehouse FW. Microalbuminuria in clinical practice. Arch Intern Med 11; 1511745-1747.

10.Diabetic Retinopathy Study Research Group. Report 7 a modification of the Airlie House classification of diabetic retinopathy. Invest Ophthmol Vis Sci 181;110-6.

11.Cole TJ, Freeman JV, Preece MA. Body mass index reference curves for the UK, 10. Arch Dis Child 15;75-.

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Childhood Obesity

If you order your custom term paper from our custom writing service you will receive a perfectly written assignment on Childhood Obesity. What we need from you is to provide us with your detailed paper instructions for our experienced writers to follow all of your specific writing requirements. Specify your order details, state the exact number of pages required and our custom writing professionals will deliver the best quality Childhood Obesity paper right on time.

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In an article regarding the current problem of obesity in todays children, Crister, Greg. "Too Much of a Good Thing." Los Angeles Times July 001. argues that we should not just stigmatize the habit of overeating also pair it with the education of proper behavioral eating habits that should begin at an early age in the home. He argues and presents data to support the recent recognition of the epidemic of childhood obesity becoming a global health issue. Our society needs to address the education of dietary restraint as an individual health concern and as a public health issue.

The recent data provided by Crister from sources indicates an increase of overweight children across the world and that this percentage has doubled over the past thirty years and this significant data has alarmed the surgeon general in that he has declared childhood obesity as an epidemic. Several medical conditions can develop as the obese child becomes an obese adult. Diabetes, high blood pressure and coronary heart disease conditions will plague the obese adult and causing that obese adult and the society as a whole, to deal with the rising medical costs to treat these conditions.

Crister does acknowledge that there have been stigmas associated with a parent putting a child on a diet. "Pressure causes tension," write Harvey and Marilyn Diamond, authors of the classic Fit for Life, which has sold more than million copies. "Where food is concerned, tension is always to be avoided (46, p)." It has been thought for several years that if a child is restrained from overeating that the child will either closet-eat or develop a loss of

Cheap University Papers on Childhood Obesity

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self-esteem that can create a lifetime eating disorder. Parents should not only educate the child of the proper eating habits but also demonstrate proper eating habits in the home.

Crister believes that obesity is a very unhealthful way of life and should be categorized as such along with smoking and non-safe sex. There are public health messages regarding prevention of smoking and non-safe sex, so why not educate the public of the need for healthy eating habits. "Its true, smokers-and homosexuals-may have experienced a modicum of stereotyping in the short run, but such is the price of every public health advance short term pain for long term gain (46, p)."

Information also presented by Crister was that in four randomized studies of obese 6- to 1-year olds, those children who were afforded the opportunity of good dietary advice were not as overweight in 10 years versus that of the children who did not receive any advice. Also found, was that thirty-percent of those studied were no longer obese at all. The knowledge of proper eating habits enables the individual to have the control of his/her weight.

We should teach our children not to overeat. The education and reinforcement of proper eating habits would not only benefit the child to grow into a healthier adult but also be a constant reminder to the parent to eat healthy themselves.

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Soccer

If you order your custom term paper from our custom writing service you will receive a perfectly written assignment on soccer. What we need from you is to provide us with your detailed paper instructions for our experienced writers to follow all of your specific writing requirements. Specify your order details, state the exact number of pages required and our custom writing professionals will deliver the best quality soccer paper right on time.

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Baseball is a sport that is so popular in the United States that it is often called the national pastime. Every spring and summer, millions of people throughout the country play this exciting bat and ball game. Millions also watch baseball games and closely follow the progress of their favorite teams and players.

There are organized baseball teams for every age group from 6-year-olds to adults. The teams that attract the most interest are those of the two major leagues the American League and the National League. These teams are made up of men who rank as the worlds best players. Every year, about 50 million people flock to ballparks to watch major league baseball games. Many more millions watch games on television, listen to them on radio, read about them in newspapers, and discuss them with their friends.

Baseball began in the eastern United States in the mid-1800s. By the late 1800s, people throughout the country were playing the game. The National League was founded in 1876, and the American League in 100. Through the years, baseball spread from the United States to other parts of the world. Today, it ranks as a major sport in such countries as Canada, Italy, Japan, Taiwan, the Netherlands, South Africa, and many Latin-American nations.

BASEBALL/How the game is played Help with essay on soccer

A baseball game is played on a large field between two teams of or 10 players each. The teams take turns at bat (on offense) and in the field (on defense). A player of the team in the field, called the pitcher, throws a baseball toward a player of the team at bat, called the batter. The batter tries to hit the ball with a bat and drive it out of the reach of the players in the field. By hitting the ball, and in other ways, players can advance around the four bases that lie on the field. A player who does so scores a run. The team that scores the most runs wins the game.

The information in this section is based on the rules of major league baseball. Most other leagues follow much the same rules. The section on Baseball leagues later in this article lists some exceptions. For information on softball, a popular game based on baseball, see SOFTBALL.

Players and equipment

Players. National League baseball teams include nine players a pitcher, catcher, first baseman, second baseman, shortstop, third baseman, left fielder, center fielder, and right fielder. Each player plays a defensive position when his team is in the field and takes a turn as the batter when his team is at bat.

American League teams include the same players, but they may--and almost always do--use a tenth player. This player, called the designated hitter (dh), bats in place of the pitcher. The dh does not play a defensive position. All other players except the dh and the pitcher both bat and play in the field. The American League adopted the designated hitter rule in 17.

Baseball teams also have substitute players. A substitute may replace any player except the pitcher at any time. A pitcher must face at least one batter before leaving the game. A player who leaves a game for a substitute may not return to the game.

Other members of a baseball team include a manager and several coaches. The manager decides which players will play in the game and directs the teams strategy. The coaches assist the manager.

Equipment. A baseball is a small, hard, round ball. It measures from to 1/4 inches ( to .5 centimeters) in circumference and weighs between 5 and 51/4 ounces (14 and 148.8 grams). A tiny cork ball forms the center of the ball. Tightly wrapped layers of rubber and yarn surround the cork. Two strips of white cowhide sewn together with thick red thread cover the ball. Until 174, the cover was made of horsehide, rather than cowhide. For this reason, baseballs are sometimes called horsehides.

A baseball bat is a long, rounded piece of wood. Most bats are made of ash wood, but some are made of hackberry or hickory. A major league baseball bat may not measure more than 4 inches (107 centimeters) long or /4 inches (7 centimeters) in diameter at its thickest point.

Each defensive player wears a padded leather glove, and uses it to catch the ball. There are three kinds of gloves the catchers mitt, which is worn by the catcher; the first basemans glove, which is worn by the first baseman; and the fielders glove, which is worn by all other players.

All players wear shoes with spikes on the soles so they can stop and start quickly. Most players wear shoes with metal spikes. But some wear shoes with synthetic rubber spikes when they play on fields covered by artificial turf. Players also wear uniforms, which include socks, knickers, a jersey, and a cap. The batter wears a special plastic cap called a batting helmet. The helmets are designed to avoid injuries to batters who are hit in the head with a ball.

A catcher wears special equipment for protection. A metal mask protects the catchers face. A chest protector of padded cloth covers the catchers chest and stomach. Plastic shin guards protect the catchers legs.

Please note that this sample paper on soccer is for your review only. In order to eliminate any of the plagiarism issues, it is highly recommended that you do not use it for you own writing purposes. In case you experience difficulties with writing a well structured and accurately composed paper on soccer, we are here to assist you. Your cheap custom college paper on soccer will be written from scratch, so you do not have to worry about its originality.

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